often in the first few hours of life. Duodenal ulcer, some congenital defect increasing intra-abdominal blood-pressure, intussusception, or hemophilia may be the cause. The child may vomit bright, unaltered blood, or the vomit may be "coffeegrounds" in character. The blood from the bowel is black in color, and is mixed with meconium, hence the name melena. It is to be carefully distinguished from the vomiting of blood derived from a fissured nipple in the mother and ingested with the milk. In melena the infant shows unmistakable symptoms of internal hemorrhage.

Treatment.-Gallic acid, gr. ij, may be given every hour.

Α

B

C

Fig. 654.—Atresia of the ureter: A, Kidney; B, ureter; C, bladder (author's case in University Maternity).

Ergotin hypodermatically, an ice-bag to the abdomen, and hot bottles to the flanks and thighs. Stimulation may be required. The mortality, in spite of intelligent and energetic treatment, is fifty per cent.

Bloody discharge from the genitalia of female children is not very rare. It shows an activity of the sexual organs analogous to the breast changes in the new-born. The condition is not dangerous, and requires no treatment. The blood comes

from the uterus, like the menstrual discharges-in fact, the discharge is a true menstruation, as has been demonstrated in postmortem examinations of infants who died from intercurrent affections. It appears three or four days after birth, and lasts only a few days.

Sudden death of apparently healthy children is an accident not infrequently demanding an explanation by the attending physician.

Among the causes may be found overlying by the mother, accidentally or intentionally. I have seen five cases. In one of the reports of the Registrar-general of England, there was a record of 1500 cases, the majority occurring on Saturday night!

Diseases. Most commonly pneumonias, apoplexies, more rarely perforation or intussusception of the bowels, rupture of a large viscus, or any of the diseases previously described, which had not been detected during life.

milk.

Occlusion of the trachea by an enlarged thymus or by curds of

Congenital deformities of important internal organs, as atresia of the ureter.

Medication of the New-born.-In administering medicine to a newly born infant, the physician should remember its peculiar intolerance of opium and its tolerance of some other remedies. The following are some of the drugs and their doses required in the first four weeks of life: Opium, only as paregoric, from two to five drops in one dose, not repeated; mercury, always as calomel, togr.; castor oil, 15 gtt. to 3j; nitrate of silver,

60

to gr.; pepsin, gr. j-ij; gallic acid, gr. ss-ij, etc.

INDEX.